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Personalizing "lower is better" for blood pressure treatment, from the May 2014 Harvard Men's Health Watch

Many men with high blood pressure were surprised—and a little confused—when a panel of experts convened by the National Institutes of Health recommended a change in the treatment goal for people over age 60. Instead of taking medications to lower pressures to 140/90, they can now settle for a target of 150/90. Several factors come into play when deciding on the best blood pressure target, reports the May 2014 Harvard Men's Health Watch.

The ideal blood pressure is under 120/80. As it rises above that threshold, the risk of heart attacks, strokes, and other health problems follows. Above 140/90, doctors generally recommend starting treatment.

For men at any age, a lower blood pressure goal for treatment is better—if they can take medications safely. "It doesn't depend on an arbitrary age," says Dr. Lipsitz, chief of geriatrics at Harvard-affiliated Beth Israel Deaconess Medical Center. "In the end, the goal of treatment—the target pressure a man should shoot for—depends on his overall health."

The amount of disease-prevention bang individuals get for their medication buck depends on their starting risks of having a heart attack or stroke. If the risk is high, there's more to gain from medication. If the risk is relatively low, medication may not help that much.

Taking three or four different medications to reach an arbitrary blood pressure target could cause dangerous side effects, especially dizziness leading to falls. Such problems are likely to appear within the first few weeks or months of taking blood pressure drugs, when the body is adjusting to them.

"It's safest to start low and go slow," Dr. Lipsitz says. "If a man starts at a small medication dose and gradually increase it over time, the body adjusts better."